Sum m a r y An out-of-body experience was repeatedly elicited during stimulation of the posterior part of the superior temporal gyrus on the right side in a patient in whom electrodes had been implanted to suppress tinnitus. Positron-emission tomographic scanning showed brain activation at the temporoparietal junction -more specifically, at the angular-supramarginal gyrus junction and the superior temporal gyrus-sulcus on the right side. Activation was also noted at the right precuneus and posterior thalamus, extending into the superior vermis. We suggest that activation of these regions is the neural correlate of the disembodiment that is part of the out-of-body experience. A n out-of-body experience is a brief subjective episode in which the self is perceived as being outside the body (disembodiment), with or without the impression of seeing the body from an elevated and distanced visuospatial perspective (autoscopy) 1 (see Glossary). Disembodiment refers to a disrupted sense of spatial unity between self and body, because the self is not experienced as residing within the limits of the body. 2 Thus, disembodiment refers to an abnormal self-location. Out-of-body experiences differ from depersonalization, in which a subjective experience of unreality and detachment from the self is experienced. Depersonalization is often accompanied by derealization, in which the external world appears strange or unreal. In depersonalization and derealization, a feeling of detachment or separation from surroundings is often noted, but not a feeling of disembodiment or autoscopy. 3 It has been suggested that out-of-body experiences are the result of a transient failure to integrate the visual, tactile, proprioceptive, and vestibular information that converges at the temporoparietal junction, especially on the right side of the brain. 1 Out-of-body experiences have attracted the most interest when reported by people who have had near-death experiences, but they have also been reported to occur spontaneously in patients with epilepsy or migraine 1 and have been induced by electrical stimulation of the temporoparietal junction on the right side in patients with epilepsy. 4,5 C a se R ep or t We report the case of a 63-year-old man in whom stimulation with implanted electrodes overlying the temporoparietal junction on the right side as a means of sup- Brief Report The New England Journal of Medicine Downloaded from nejm.org on February 9, 2012. For personal use only. No other uses without permission
